PATHO FALL 2006
Terms
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- 5 CAUSES OF hypoxemia
-
1)DECREASED BAROMERTRIC PRESSURE
2)v/q mismatch
3)SHUNT
4)DIFFUSION DEFECT
5)HYPOVENTILATION - in the alert patient, a v/q mismatch is caused by
- shunt
- requirements for NIV
- patient must be homedynamically stable for NIV. IF patient is hypoxemic and hypotensive, they need mechanical ventilation
- ways intubation can be verified
-
1)breath sounds
2)anterior chest rise with bagging
3)CAPNOGRAPHY
4)vapor trail
5)increasing spo2
6)bronchoscopy - patients with CHF may have wheeze
- because of the engorgement of the vessels in the pulmonary vascular system
- a left mainstem pneumothorax will sound
- typmanic on the left, normal on the right
- a right mainstem intubation will be
- normal on the right, dull on the left
- volume assured pressure support
- breath starts out pressure supported, but changes to volume at the end of the breath, if the machine determines that significant volume will not be delivered by pressure support alone
- how volume assured pressure support determines that volume is inadequate
- by extrapolating based on flow
- prvc cycles into exhalation by ------
- TIME
- AGITATed patient on prvc
- increases their WOB and gets more delta p
- if delta p is increasing on prvc
- the patient's condition is worsening, or the patient's inspiratory effort has increased
- pressure targeted modes can be set with a constant i time or
- a constant i:e ratio
- if the i:e ratio is set
- making rate changes may mean that the patient has been saddled with an i time he cannot synchorinize with
- applying PEEP on a ventilator
-
1)increases frc
2) PREVENTS or reverses alveolar collapse
3)IMPROVES gas exchange
4) moves the vt on the compliance curve
5)increases MAP - ventilators with floating exhalation valves
- allow for spontaneous breathing whether the patient is set in bilevel or not
- volume control in the servo I
- has a pause time set in order to reach optimal levels of MAP
- some patients in heart failure
- may benefit from the decreased venous return(E.g, decreased preload) from the vent
- hallmark of diaphragmatic paralysis is
- SOB in the supine position
- causs of neuromuscular weakness
-
1)hypothyroidism
2)Electrolyte imbalance-po4 less than 1. low or high mg,ca, or k.
3)critical illness polyneuropathy
4)high c spine injury